Healthcare Provider Details

I. General information

NPI: 1316394810
Provider Name (Legal Business Name): TRACY PIKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 W ORANGE GROVE RD # 164
TUCSON AZ
85741-2824
US

IV. Provider business mailing address

3600 W ORANGE GROVE RD # 164
TUCSON AZ
85741-2824
US

V. Phone/Fax

Practice location:
  • Phone: 360-388-5334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number14164
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: